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OB/GYN final Flashcards

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1
Q

advantages/disadvantages of radiation treatment in cervical cancer

A

advantage: able to use direct appliation of radiation
disadvantage: can damage the vaginal tissue so is reserved for older women

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2
Q

five tocolytic drugs

A

calcium channel blockers

magnesium sulfate

beta sympathomimetics

oxytocin

alcohol

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3
Q

why are submucosal fibroids concerning

A

because they interfere with the smooth muscle contraction of the uterus, preventing vasoconstriction and allowing for heavy bleeding

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4
Q

treatment of ovarian torsion

A

spontaneous revision with knee to chest position

laproscopy to untwist and fixate, oophorectomy if the ovary is necrotic

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5
Q

what is the effect of postmenopausal HRT on breast cancer

A

estrogen + progestin increases risk, estrogen alone does not

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6
Q

compare and contrast open, fine needle, and core needle biopsies for breast masses

A

open is the most reliable

fine needle is the least invasive but has a higher false negative rate and needs US or Xray guidance

core needle has fewer false negatives

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7
Q

what is the most common bone disorder in the US

A

involutional osteoporosis

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8
Q

gynecological menopause symptoms

A

amenorrhea

vaginal dryness

sexual dysfunction

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9
Q

patient presents with postive immunochemistry with an uneffaced cervix 1cm dilated and no regular contractions

what is the Dx

A

preterm PROM

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10
Q

mild preeclampsia

A

BP > 140/90 on two or more occasions 6 hours or more apart after 20 weeks

proteinura 300-2000 mg/24 hours

commonly have edema

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11
Q

four strategies to avoid hyperemesis

A

early intervention

outpatient IV hydration

corticosteroids (medrol)

antiemetics (compazine, zofran)

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12
Q

two characteristics of ovarian dysgenesis

A

early loss of oocytes

failure of germ cell migration

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13
Q

differentiate between CIN and CIS

A

CIN = cervical intrepithelial neoplasia, can be mild, moderate, or severe dysplasia

CIS = carcinoma in situ

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14
Q

menopause will cause a dramatic reduction in estrogen leading to an increase in FSH

what organ systems will this effect

A

reproductive

bone

CNS

CV

metabolic

skin

urinary tract

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15
Q

if estrogen is low, what other lab values should be high?

if they are low what is indicated

A

FSH and LH

there is a loss of GnRH from the hypothalamus

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16
Q

patient pregnant at 24 weeks complains of dyspnea. PE shows midsystolic murmur along the left sternal border, PMI displaced to the left, jugular venous distension

how concerned are you about this patient

A

only mildly concerned, all of these symptoms can be normal sequela of pregnancy

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17
Q

T/F quantitative HCG can help determine gestational age

A

false, HCG levels are too variable, unless the value is really low (indicates very early)

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18
Q

management of a threatened SAB

A

compassion

ultrasound

reassurance

arrange for follow up (1-2 weeks)

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19
Q

T/F screening is strong correlated with breast cancer survival

A

false, there is only a small increase in survival, a lot what we are picking out are not aggressively malignant similar to prostate cancer

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20
Q

what is the benefit treating bacterial vaginosis to manage preterm PROM

A

there isn’t any support

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21
Q

DES defined

uses

A

diethylstilbesterol, synthetic estrogen used to treat or prevent miscarriage, low birth weight, poor OB outcome

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22
Q

anencephaly

A

failure of the brain to develop

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23
Q

management options for hypothalamic amenorrhea

A

reduction in stress, gain weight, exogeneous GnRH pump, exogenous FSH and LH, birth control pills

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24
Q

cancer associated with BRCA2

A

breast cancer

ovarian cancer

pancreatic cancer

prostate

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25
primary vs secondary amenorrhea
primary = none, never secondary = had periods but stopped
26
nulliparous
never brought a pregnancy to term
27
patient 32wks G1P0 pregnant presents with borderline hypertension, trace protenuria, DTRs +2/4 at a bwt of 137. what might you suspect? two weeks later the patient presents with significant HTN, +2 proteinuria, hypereflexia, and 11lbs weight gain what is indicated
beginings of a HTN disorder related to pregnancy preeclampsia requiring hospitalization
28
nulligravida
never been pregnant
29
supplemental progesterone treatment for preterm labor
vaginal progesterone injections of 17-OH progesterone
30
uterine prolapse symptoms incidence
pressure or heaviness, possible bowel and bladder symptoms common 20-30%
31
intermediate forms of GTD
chorioadenoma destruans placetal site-trophoblastic tumor
32
parous
33
how many couples will experience infertility in their lives how many women
8-14% 25%
34
late deceleration what do they indicate
bradycardia in response to a contraction indicates that the baby is hypoxic
35
two highlights of the second trimester
time of rapid and major physiological adjustments fetal viability happpens around 22 weeks
36
treatment for obesity associated with PCOS
diet and exercise along with metformin, possibly for life
37
examination of amenorrhea
pelvic exam US endoscopy \*hysteroscope) hysterosalpingogram
38
why does the risk of spontaneous abortion go up with age
because you have a higher risk for genetic abnormalities that will not produce a viable fetus
39
when is MRI mammography useful
high risk patients (BRCA1, 2, FHx)
40
best guess at a cause for preeclampisa
alteration of placental physiology that results in loss of substances that normally reduce vascular resistance
41
what is the trade off from mammography
reduce mortality by 8 per 100,000 increase false positives by 122 per 100,000
42
four types of emergency contraception
progestin only (plan B) Yuzpe method IUD insertion withine 5 days Progesterone receptor blockers
43
T/F dermoids are maglignant
false, they are benign but they do destroy normal ovarian tissue if they grow
44
Rh hemolytic disease (Erythroblastosis Fetalis)
the reaction of anti-d IgG produced by the mother if exposed to Rh+ blood that can cross the placenta and cause hemoylsis
45
patient with narrow pelvic inlet and DMI is laboring with a fetus with a large biparietal diameter. The feus begins to experience late decelerations. is oxytocin indicated what if the presentation was breech
no to both
46
how common are abdominal pregnancies what is the mortality rate how is this managed
1/100,000 very rare 25% maternal, 90% fetal delivery fetus, leave placenta in situ
47
acanthosis nigricans
dark, velvety skin in the folds and creases
48
what is the most significant risk factor for neural tube defects
folic acid deficiency
49
assessing preterm labor risk
cervical length by ultrasound fetal fibronectin in maternal serum
50
general prognostic factors for breast cancer
best age is 40-70 preexisting conditions can limit treatment staging receptor status and genetic profile
51
placental abruption (abruptio placentae) main symptoms
premature separation of the placenta bleeding, pain at the sight of placental separation, labor pains
52
risk factors for involutional menopause
gender genetics smoking low calcum intake early menopause
53
four disadvantages of chemotherapy with methotrexate for ectopic pregnancy
mandatory follow up frequent HCG testing (may take 2 months to go down) works poorly on advanced gestations
54
what is the only cure for preeclampsia T/F there can still be related issues up to 72 hrs later
delivery true
55
preventing bladder atony
keep bladder empty during labor watch for distended bladder post partum catheterize as needed
56
which of the vaginitis big three is sexually transmitted
trichomonaisis
57
should EDD be revised when ultrasound indicated a different date than intial physical exam
yes, ultrasound is pretty accurate
58
what is the most common germ cell ovarian cancer
dysgerminoma
59
how is a breast cyst managed clincially when should it be biopsied
outpatient aspiration if its the first cyst, it is still present after aspriation, or the fluid aspirated is cloudy
60
types of estradiol used in HRT
tablets (estrace) patch (estraderm) spray (evamist)
61
differentiate between placenta accreta/increta/pancreta
accreta is less invasive, increta moderate, pancreta complete investion of the uterus and requires hysterectomy
62
dropping
descent of the baby's head in to the pelvic inlet
63
what fetal measurements are taken during an OB ultrasound
skull abdominal circumference femur length
64
types of epithelial ovarian cancer
serous cystadenocarcinoma mucinous cystadenocarcinoma
65
three ways to evaulate reccurreny SAB
chromosomal analysis of peripheral leukocytes from both partners TSH and T4 screen evaluate uterus (hysterosalpingogram, sonohysterography, hysteroscopy)
66
what causes a T shaped uterus when exposed to a fetus
DES
67
causes of osteoporosis
endocrine (cushings, hyperparathyroidism) renal disease, esp ESRD medication side effect involutional
68
what suppresses lactation during pregnancy what happens after delivery
estrogen, progesterone, placental lactogen delivery ends suppression
69
complications of the third stage of labor (placenta delivery)
postpartum hemorrhage PP infection (endometritis) uterine inversion
70
hypothalamic/pituitary causes of amenorrhea
loss of GnRH from stress, low body fat, or congenital cause hyperprolactinemia
71
biparietal diameter
a measurement of the skull through the septum pellucidum used to estimate gestational age accurately after 13 weeks
72
aglutination of enzmes lcan lead to what
hemoylsis and anemia, which can lead to heart failure
73
treatment of the big three vaginitis
oral or topical fungicides for monilia oral or topical metronidazole for trichomoniasis and bacterial vaginosis topical clindamycin for bacterial vaginosis
74
criteria for macrosomia
10lbs or more
75
premature rupture of membranes defined how common is it? risk factors cause
rupture of membranes before labor 5-10% similar to preterm labor unknown
76
special risks associated with PCOS
unopposed estrogen increases risk of endometrial carcinoma high androgens -\> dyslipidemia insulin resistance -\> DMII
77
how will clue cells look like on a microscope slide
epithelial cells with granular bacterial inclusions
78
evaluation of a submucosal fibroid
pelvic exam may or may not reveal a submucosal mass, US is better
79
what is the most common cause of a septic abortion diagnostic factors
contamination after uterine instrumentation following illegal abortions fever; discharge; pelvic pain; leukocytosis; elevated SED rate
80
etiology and symptoms of cystadenomas
unknown, but they are benign discomfort, bloating, constipation, gerd
81
T/F SERMs are useful for hot flashes but not osteoporosis
false, its the other way around
82
factors that increase risk for ovarian cancer
age genetics (familial, BRCA1-2, ashkenazi) high fat diet PCOS
83
goals of HRT for menopause
reduce hot flashes improve sleep to improve congition and reduce psychological symptoms prevent bone loss maintain health of the vagina, uterus, bladder
84
psychological menopause symptoms
mood changes loss of concentration irritability
85
three key assesment points during vaginal exam to determine if a laboring woman should be admitted
dilation effacement station
86
Whiff test for vaginosis
KOH on a vaginal secretion slide will produce a fishy smell with gardnerella vaginalis
87
treatment for ovarian cancer
surgery to cure stage 1-2, or debulk stage 3-4 for better chemo chemo
88
DES increased risk for what four things in offspring
vaginal cancer in female offspring miscarriage/ectopic pregnancy premature labor infertility
89
methods to suppress the ovaries in endometriosis treatment how long should treatment last
pregnancy steroid contraceptives progestins GnRH agonists mild androgens at least 6 months
90
three abruption risk factors
medical, gynlogical, other
91
30 yr old patient attempting to get pregnany comes to the clinic to seek infertility treatment after 1 month of unprotected sex. how should be cancelled what if she were 35+ 40+
less than 35 should try 1 year of unprotected sex before attempting infertility treatment without obvious issues 6 months immediately
92
what is the ultimate goal of infertility treatment
prenancy, adoption, or acceptance of life without children
93
causes of miscarriage
unhealthy embryo hormone imbalances uterine malformations infections immunologic problems
94
what is the goal of tocolysis to delay preterm labor
allow transport to appropriate place to deliver allow time for glucocortcoid therapy
95
three types of surgical sterilization for women
postpartum "mini-laparotomy" tubal laparoscopic coagulation or application of occlusive clips/rings hysteroscopic
96
what might low amniotic fluid levels indicate
renal issues or an unhealthy fetus
97
what is the only method of breast cancer screening that is capable of finding non-palpable breast cancer
mammography
98
T/F hyper or hypo thyroid can cause reccurent abortion
true
99
what is the most common GYN problem in women from 15-45 symptoms
cervicitis/vaginitis/vulvovaginitis vaginal discharge; vaginal or vulvar irritation; odor esp with bacterial vaginosis
100
21 y/o G0 presents with irregular menstrual cycles, hirsutism Hx Menarche was at age 13, Periods always irregular (q 3-8 months), LMP 5 months ago what might you suspect
polycystic ovarian syndrome hyperprolactinemia hyper/hypothyroid
101
define the perinatal death (mortality) rate
the number of still births and neonatal deaths per 1000 births
102
what constitutes complete cervical dilation
10cm
103
metabolic factors leading amenorrhea
hypothyroid hyperprolactinemia chronic illness insulin resistance/anovulation (PCOS)
104
GI premature disease
necrotizing enterocolitis
105
what percentage of women have PCOS what is the genetic transmission
4-6% autosomal dominant transmission with variable pentrance
106
two types of epithelial carcinoma categorized as breast cancer one special category
intermediate type ducts (ductal carcinoma) terminal lobular ducts (lobular carcinoma) carcinoma in-situ
107
patient with PCOS comes to clinic seeking to regulate periods and treat hirsutism what is the best treatment option
birth control as long as she doesn't want to get pregnany
108
patient G3P2002 presents at 33 weeks with bright red vaginal bleeding DDx
loss of cervical plug cervical bleeding from polyps or hyperemia iatrogenic from digital cervical exams placenta previa placental abruption
109
two ways to augment labor and delivery
intravenous oxytocin and assisted fetal extraction
110
four ways to evaluate fetal health in late pregnancy
growth measurements biochemical markers biophysical assesments placental assessment
111
cause of uterine prolapse symptoms incidence
weakening of uterine support caused by congenital causes, obstettrical causes, hypoestrogenism, or increased intraabdominal plressure
112
early deceleration what does it indicate are they concerning
transient bradycardia that looks to start when the contraction starts and ends when it ends represents head compression not really, it just means delivery is coming
113
two types of vertex malpresenstations
occiput transverse (OT) occiput posterior (OP)
114
surgical treatment of mullarian agenesis
exicision of the transvaginal septum inciision/resection of hymen construction of a neovagina hysteroscopic adhesiolysis
115
three accepted uterine causes of recurrent abortion
septum, scar, fibroids
116
common causes of oligomenorrhea
PCOS/PCOD hyperprolactinemia hyper/hypothyroid
117
treating hirsutism associated with PCOS
contraceptive steroids or antiandrogens (spirolactone/aldactone or finasteride/propecia)
118
apgar muscle tone scores
0 = none 1 = some flexion 2 = active movement
119
two indications of failed germ cell migration
streak or absent gonads XX or XY chromosome
120
menstrual irregularity treatment
intermittent progestins (medroxyprogesterone acetate/provera 10mg x 10days every 1-3 months) contraceptive steroids (birth control, contraceptive patch, nuva ring)
121
dermatologic menopause symptoms
dry skin age spots
122
treatment for a molar pregnancy
suction curettage monitor HCG for one year 2% risk of repeat molar pregnancy
123
three clinical forms of preeclampsia/eclampsia
mild preeclampsia severe pre eclampsia
124
menopause
cessation of menses for 6-12months due to natural, surgical or other causes
125
two methods of assisted fetal extraction
forceps vacuum extraction
126
three distinctive presentations of a rupture ectopic pregnancy
massive blood loss severe pain syncope
127
why give glucocortcoids to someone in preterm labor
forces the development of the fetal respiratory system
128
clincal features of osteoporosis
wrist, hip, vertebra fracture loss of height due to compression fractures chronic back pain
129
treatment of abruption
delivery via emergency c section or expeditious vaginal deliver tocolysis for fetal distress volume replacement
130
treatment and hazards of cystadenomas
surgical excision torsion, mucinous peritonitis if it ruptures, death due to size and pressure on other organs
131
how common is benign first trimester bleeding where does it come from what is a possible cause
common from the cervix possibly to the luteal-placental shift
132
can placenta previa be fatal what is a major risk
yes if an examining finger is inserted through the placenta
133
describe the process of engagement during labor
1. head floating before engagement 2. engagement (the lowest part of the fetus pressing against the pelvis) and flexion 3. internal rotation (head turns anteriorly from transverse) 4. begining extension of the neck 5. complete extension (delivery of the head) 6. external rotation (head turns transverse) 7. delivery of the anterior shoulder with gentle downward traction 8. delivery of the posterior shoulder with gental upward traction
134
methods of intrauterine contraception
IUD (Copper, mirena, Skyla, Liletta) endometrial ablation
135
indications of supine hypotensive syndrome treatment
anxiety, sympathetic discharge, syncope lay on your side or on your back elevated 30 deg
136
pseudocyesis
false pregancy related to stress, bloating caused by gas
137
why are xrays not reccomended for imagining a fetus prior to 14 weeks
because the bones arent visible \<14 weeks and the radiation is harmful
138
how long is a typically pregnancy from fertilization from LMP
266 days after fertilization 40 weeks after LMP
139
why is the baby at risk for brain anoxia with shoulder dystocia
because it can take 5+ minutes to delivery the baby
140
33 y/o G2 P2002 presents with complaint of severe fatigue and shortness of breath. CBC shows severe anemia, Hgb = 6.2 g/dl. Menstrual cycles are regular (every 28-30 days) but increasingly heavy over the past 6 months DDx
submucous leiomyoma PCOS (but periods should not be regular) coagulopathy
141
severe preeclampsia
BP 160/110 OR severe proteinura (\>2g/24hrs) OR oliguria (\<500mL/24hrs) OR Liver abnormalities (RUQ pain) OR thombocytopenia (\<100,000/mm^3)
142
miscellaneous causes of placental abruption
trauma, heavy lifting, smoking
143
patient G3P2002 presents at 33 weeks with bright red vaginal bleeding, no recent cervical exams, normal painless uterus, low placenta Dx treatment options
probably placenta previa Csection, expectant mangament if the bleeding stops
144
is there a value for mammography in ages below 40? 40-50 70+
no because the breast is more dense maybe no proven value after 70
145
two key lacatation hormones
prolactin oxytocin
146
primipara
giving birth for the first time
147
respiratory premature disease
RDS chronic lung disease
148
what is the anatomical landmark for a nonpregnant or nulliparous uterus
none, it is about the size of your fist or slightly smaller for nulliparous
149
prevention of cervical cancer
HPV vaccine pap smear to detect cervical intraepithelial neoplasia
150
management of a total previa partial low lying
c section vaginal delivery may be possible vaginal delivery is usually possible
151
what would a cervical length of greater than 25mm indicate
very low risk for preterm labor
152
anesthetic options for the use of forceps
epidural pudendal block local anesthetic
153
surgical menopause
removal of both ovaries
154
Dx of ovarian torsion
ultrasound showing a mass with no arterial flow on doppler
155
four characteristics of a benign adnexal mass
unilateral, mobile, cystic, small (\<5cm)
156
DDx for acute pelvic pain
PID ovarian torsion ruptured endometrioma ectopic SAB
157
surgical treatment of an unruptured ectopic
salpingostomy salpingectomy laparotomy
158
what is the anatomical landmark for a gravid uterus at 12 weeks
palpable at or just slightly above the pubic symphysis
159
two highlights of the first trimester
fetal stage of development starts at 10 weeks most pregnancy losses happen here
160
preventing ecclampsia what must be done during this time
IV magnesium sulfate monitor for overdose (urine output, renal function, reflexs, mental status)
161
missed abortion three patient issues associated
SAB where the uterus fails to evacuate the pregnancy within 8 weeks of embryo demise patient anxiety; possible formation of a calcified mass; small risk of coagulopathy
162
is ovarian torsion common in a normal ovary
no, the ovary is usually enlarged from a benign cyst, dermoid, or hyperstimulation
163
what are the three most common causes of infertility
egg or ovulation sperm tubal or pelvic
164
PP CV and metabolic changes
weight loss blood loss (500-1000mL), usually normal at PP wk3 rapid fall in insulin resistance coagulation changes (rapid decrease in fibrinogen, secondary peaks of fibrinogen and platelets) lipid chemistry normal \<1week
165
what is the source of many idiopathic cases of infertility and treatment failure
infertility due to female age
166
prevention of Rh hemolytic disease
give Rhogam, coats the d antigen in artificial IgG so mom never has a change to react
167
risk factors for ectopic pregnancy what percent will have at least one risk factor
previous salpingitis (PID) previos ectopic pregnancy prior tubal surgery cigarette smoking 50%
168
alternative causes of PCOS that should be excluded
nonclassical congenital adrenal hyperplasia androgen secreting tumor cushing syndrome
169
usual criteria for admission of a laboring pregnant woman
active labor rupture of membranes abnormal bleeding maternal or fetal health issues if you aren't sure, reevaluate in 1-2 hours
170
other types of GYN cancer vulvar vaginal
vulvar: squamous carcinoma, malignant melanoma vaginal: clear cell adenocarcinoma (DES) esxposure
171
what is the general strategy for the use of clomid
use as much as necessary but as little as possible expect rapid response (1st 3-4 months) no effect in continuing beyond 6 months
172
etiology of PID
infection (gonorrhea, chlamydia, anaerobes) or STI that causes bilaterally inflammation of the fallopian tubes that can form a tubo-ovarian abscess
173
why are choriocarcinomas dangerous but treatable
they grow very fast and become lifethreatening, but respond well to treatment
174
what is Ondansetron (zofran) used for in early pregnancy
to treat nausea
175
three types of breast mass biopsy
open (excisional) fine needle core needle
176
disseminated intravascular coagulopathy is a risk factor with placental abruption what should you look for in this
falling platelet count elevated fibrin split products
177
what is the common cause of subclinical PID what are the symptoms what is the risk
chlamydia mild cramping, no pain or fever can cause infertility or ectopics due to tubal damage
178
vagina pessaries
a plastic ring inserted into the vagina to help support a prolapse uterus
179
why is rupture of membranes relevant
can trigger labor infection (chorioamnioitis)
180
what two things would make asherman's syndrome more likely
some kind of trauma, possibly surgical, that leads to infection
181
what is the goal of delaying preterm labor
to allow for the production of surfactant to prevent alveolar collapse
182
what percent of breast cancer is associated with BRCA1-2
5-10%
183
what risk is associated with gestational HTN should it be treated
higher risk of HTN later on only if it is severe \>160/110
184
16 yr old patient presents with positive HCG and ultrasound indicating 16 wks. What are four issues that might be of concern
school issues nutrition substance abuse social support/newborn care
185
PCOS characterized by what
enlarged ovaries with multiple arrested cysts, oligomenorrhea/amenorrhea, and hyperandrogenism
186
patients commonly afflicted with primary dysmenorrhea possible cause? treatment
young women with ovulatory menstrual cycles abnormal prostaglandin metabolism treatment with antiprostaglandins or suppression of ovulation
187
what is the percent breakdown of HTN during pregnancy
30% is chronic, 70% is pregnancy induced
188
what is the most common symptom of endometrial cancer
abnormal uterine bleeding or postmenopausal bleeding
189
issues to look for in the health portion of the HEST workup
pelvic exam look for infection (HIV, HepB/C) changes to immune status (rubella, hepatitis) TSH Genetic screening
190
why is the low transverse uterine incision preferred for a C section what is the disadvantage of the classical incision on the fundus
the uterus is thin, it easy to get to and heals well high rupture rate
191
are self breast exams positively correlated to survival are they still useful
no useful in a diligent patient using good protocol during cycle day 6-10
192
what is necessary treatment for a ruptured ectopic
salpingectomy and blood transfusions
193
velamentous insertion
the umbilical cord inserts into the chorioaminotic membranes and travels from there to the placenta
194
first trimester 2nd 3rd
conception through 13 weeks 14-27 28-40
195
where is prolactin produced what does it do
anterior pituitary stimulates milk production by breast glandular tissue
196
etiology and symptoms of adenomyosis
unknown etiology, common in women 35-45 and abates at menopause dysmenorrhea and menorrhagia
197
patient presents with 45X genome, short stature, coartation of the aorta what GYN issue would you expect
early loss of oocytes (turner syndrome)
198
two types of episiotomy
midline mediolateral
199
when is placenta previa usually seen what is the cause
after 36wks gradual cervical effacement and dilation is the trigger
200
describe the relationship between breast cancer and age before what age is breast cancer less likely what is the mean age at diagnosis what is the time from origin to dianosis
risk increases with age 40 unless genetically predisposed 60-61 2-8 years
201
management of adenomysosi
diagnosis with MRI or ultrasound supportive treatment with nsaids, analgesics, or ovarian suppression surgical treatment with hysterectomy or segmental resection
202
classic presentation of placental abruption
painful third trimester bleeding
203
why are triple negative breast cancer the ones with the worse prognosis
because they are not receptive to anti-estrogen/progesterone/HER-2 drugs
204
types of tubal contraception
surgical inflammatory occulsion
205
HTN drugs to stop during pregnancy
ACE inhibitors ARBs beta blockers thiazides
206
describe lobular CIS
localized carcinoma that is not truly malignany but increase the risk of later malignancy by 20%
207
five characteristics of a maglignant adnexal mass
bilateral, fixed, solid or semi-cystic, larger than 5cm, ascities
208
big three causes of vaginitis
monilia (candida albicans) trichomonaisis bacterial vaginosis (gardnerella vaginalis)
209
precipitate labor
delivery with in 2 hours of the start of labor most often seen in multiparous women
210
three factors that would warrant infertility evaluation at any time
amenorrhea known tubal Hx male infertilty Hx
211
egg/ovulation test for HEST workup
FSH and estradiol (E2) testing on cycle day 2 or 3 serum progesterone
212
when would a laparotomy be necessary surgical treatment for ectopic pregnancy
ruptured ectopics, interstitial (cornual) ectopics, significant pelvic adhesions
213
PE findings associated with acute salpingitis
cervical motion tenderness bilateral adnexal tenderness usually present
214
three stages of labor
1st: from beginning of labor to complete cervical dilation 2nd: from complete cervical dialtion to delivery 3rd: ends with delivery of placenta
215
uterine inversion what is the treatment
when the placenta fails to detach from the uterus and pulls the organ out of the vagina put it back in
216
what causes decreased insulin sensitivity in the second and third trimesters
human placental lactogen, prolactin, cortisol
217
management of a submucosal leiomyoma that is causing anemia
possible transfusion if hemodynamically unstable additional folic acid and iron GnRH agonists to decrease FSH and LH to stop menstruation (leupron) surgical resection
218
what is the action of clomphene citrate what are the possible side effects
inhibits estrogen, induces the release of FSH and LH functional ovarian cysts; decrease cervical mucus; decreased endometrial growth; hot flashes
219
chemotheraputic agent for unruptured ectopic
methotrexate
220
treat ment of mild preeclampsia
prevention deliver +37 weeks admit \<37 weeks
221
three uses of OB ultrasound
check for fetal anomalies evaluate the placenta take fetal measurements
222
treatment of invasive cervical cancer
radiacl hysterectomy with lymph node dissection radiation therapy chemo (adjunctive)
223
McRoberts manuver
hyperflexing the mother's legs against the abdomen that allows for rotation of the pelvis and delivery of the anterior shoulder
224
The presence of which of the following distinguishes eclampsia from preeclampsia? A. hypertension B. proteinuria C. seizure D. thrombocytopenia
The answer is C [Ob/Gyn]. A. Preeclampsia and eclampsia both manifest with hypertension, proteinuria, and thrombocytopenia. B. See A. C. When seizure occurs, the patient goes from a diagnosis of preeclampsia to that of eclampsia. D. See A.
225
pregnant patient G2P0010 presents with positive home pregnancy test, LMP 9 weeks ago, intermittent vaginal bleeding for 1 week, LLQ pain getting worse for 12 hours, Hx of right tubal pregnancy 3 yrs ago what is suspected how is she evaluated
ectopic pregnancy confirm or exclude by vaginal ultrasound
226
what type of US is best in the first trimester why
vaginal confirms location of gestation; determine embryo viability; relief of anxiety
227
NY heart assocation classification
Class I: asymptomatic with ordinary activities Class II: symptomatic with greater than normal activity Class III: symptomatic with normal activities Class IV: symptomatic at rest
228
gravidity
how many times someone has been pregnant
229
gestational HTN
BP \> 140/90 on two or more occasions 6 hours or more apart after 20 weeks with no proteinuria
230
chronic HTN is associated with what four pregnancy risks
preeclampsia/eclampsia placental abruption preterm labor intrauterine growth retardation
231
fibroid etiology what determines the symptoms
a single myometrial cell mutation found in 20-50% of women that is estrogen dependent symptoms are depedent on location
232
how often do hot flashes usually occur when does the activity peak what percent will have significant problems
1-12 hours, even during sleep 3-5 after onset of menopause then declining 5-10%
233
when is vaginal ultrasound used for imaging a fetus abdominal
first trimester \>12 weeks
234
symptoms of endometriosis when would it cause severe abdominal pain
none, infertility, dysmenorrhea, dyspareunia when there is a ruptured endometrioma
235
Young sexually active patient on birth control presents with pelvic pain. She is afebrile and WBC count is normal. Serum HCG \<5 mIU/ml. Pelvic exam unsatisfactory due to guarding and severe pain left adnexa. Ultrasound shows 6 cm fluid-filled mass in left adnexa DDx?
ovarian torsion
236
sources of morbidity associated with ovarian cancer
intra-abdominal spread obstruction or malabsorption in the GI tract distant mets (liver, lung, bone)
237
will giving progesterone during pregnancy hurt a fetus
no, progesterone goes up during pregnancy
238
patient in the first trimester has an HCG greater than 2,000 but no IUP on vaginal ultrasound what is the probable cause
ectopic pregnancy
239
apgar categories
color pulse reflex/irritability muscle tone breathing
240
three risk factors associated with endometritis treatment
long labors, multiple vagina exams, failure of sterile technique IV ABx
241
treatment of severe preeclampsia
prevention deliver regardless of gestational age delay for 24-48 hrs for glucocortcoids if \<34 weeks
242
T/F delayed childbearing decreases risk of breast cancer
false, pregnancy after 35 increases risk by 1.5x
243
natural menopause
exhaustion of the ovarian supply of oocytes
244
during the first trimester insulin needs will \_\_\_\_\_\_ during the second and third they will \_\_\_\_\_\_\_
stay the same or go down increase dramatically
245
musculoskeletal menopause symptoms
fractures/osteoporosis
246
how does bisphosphonates work against osteoporosis disadvantages
blocks bone resorption increases bone mass reduces plasma calcium levels needs to be taken on a empty stomach due to poor absorption, can often cause GI issues
247
integrated theory of endometriosis
high retrograde menstruation allows for endometrial cells to implant or grow attenuated immune system allows for aggressive spread through blood or lymph
248
use of the word miscarriage vs abortion
abortion should not be used with patients
249
vaginal septum
a septum in the uterus that can cause dyspariena or dysmenorrhea
250
what age is mostly likely to present with acute salpingitis typical symptoms and signs
teens and early 20s bilateral lower abdominal cramping and pain with possible fever, purulent discharge that begin during or after menses
251
risks of Estrogen HRT
increased breast cancer risk increased risk of CVD increased risk of DVT (thromboembolism) increased risk of uterine cancer unless prgesterone is added
252
primigravida
first pregnancy
253
clubbed fallopian tubes hydrosalpinx what is the major concern with hydrosalpinx
scarring and inflammation has destroyed the fimbria blocked fallopian tube filled with fluid the mucosa inside will be damaged and even with surgery to open the tube it may not be functional
254
SAB first phase
6-9 weeks of gestation, intermittent bleeding and cramping
255
A 30-year-old female who is 32 weeks pregnant begins to experience tremors, heat intolerance, and irritability along with some fatigue, tachycardia, hypertension, and lower abdominal pain. Labs reveal the following: Hct 33%; Hgb 12.8 g/dL; WBC 14,600/L am cortisol 42 g/dL (normal 5 to 20 g/dL) Total thyroxine 13.1 g/dL (normal 5 to 12 g/dL) Total T3 225 ng/dL (normal 70 to 205 ng/dL) TSH 0.4 U/mL (normal 2 to 10 U/mL) Which of the following therapies is the treatment of choice? A. amiodarone B. propranolol C. propylthiouracil D. radioactive iodine
The answer is C A. Amiodarone can be a cause of hyperthyroidism and is not used for the treatment. B. beta Blockers may alleviate symptomatology of hyperthyroidism but may cause fetal growth retardation. C. Hyperthyroidism results in low TSH and elevated T3 and thyroxine (free T4). It may cause intrauterine growth retardation, prematurity, or transient thyrotoxicosis in the newborn. Propylthiouracil is the only drug recommended for treatment of hyperthyroidism during pregnancy and lactation. This drug does cross the placenta and, although rare, may result in excess TSH secretion and goiter in the fetus. Therefore, the smallest dose possible should be used. Very little is secreted in breast milk; adverse effects in the fetus have not been demonstrated. D. Radioactive iodine would be harmful to the fetus.
256
screening protocol for cervical cancer
begin 3 years after sexual activity or 21-25 q3yrs as long as results have been normal q5yrs after 50 stop at 65 (or 70) with 5 normal paps
257
causes of oligohydramnios signs
urethral stricture, kidney malformation distended bladder on ultrasound
258
when would you suspect ectopic pregnancy
first trimester bleeding accompanied by cramping midpelvic pain intially progressing to knife-like localized pain
259
T/F episiotomy is reccomended for a routine non-operative delivery
false
260
guidelines to determine if salpingitis should be admitted
fever above 39C WBC +20,000 guarding and rebound tenderness with severe pain
261
what would result in paternal genome 46yy in a hydatidiform mole
dispermic fertilization or maternal pronucleus inactivation
262
what is the main cuase of cervical cancer two synergistic factors
HPV smoking and immunosuppression
263
classic presentation of placenta previa
painless third trimester vaginal bleeding
264
which of the Rh genes are most important
D DD - Rh positive Dd- Rh positive dd - Rh negative
265
evaluation of post menopausal bleeding
TV US to measure endometrial thickness, biospy if \<3mm endometrial biopsy \>3mm dilation and curettage in the case of cervical stenosis
266
staging endometriosis when is aggressive treatment warranted
mild I and II moderate III severe IV with stage III, IV, or with a patient less than 25
267
what is an effective treatment for HER-2 sensitive breast cancer
monoclonal antibodies against the receptors
268
what drug is in Plan B when are the best given what is the method of action what is the main side effect
levonorgestrel pills best results within 72 hours blocks ovulation nausea
269
puerperium what happens to the uterus day 1 PP what is a common procedure done at this time? why?
delivery to 6 weeks it shrinks to size it was at during week 20 (palpable at the umbilicus tubal ligation, because the uterus is right at the umbilicus for easy access
270
changes in menstrual cycle during perimenopause
regular cycles with less bleeding and cramping irregular cycles
271
why would oral contraceptives stunt growth of a functional ovarian cyst
using the estrogen and progestone to decrease follical development through lower FSH and LH
272
what is the most common form of GTD
hydatiform mole
273
# define adenomyosis indicence
endometrial glands and stroma within the myometrium 8-40% of all hysterecyomes
274
what is secreted during lactation in the intiial 1-3 days PP what makes it special
colostrum low in fat and CHO, high in vitamins and immunoglobulins
275
5 minor risk factors for preterm labor
poor weight gain working smoking anemia infection
276
succenturiate lobe
accessory lobe of the placenta
277
T/F all the biochemical markers used to monitor fetal heatlh (estriol, human placental lactogen, HCG, etc) have not proved useful
true
278
what type of ovarian cancer can secrete steroid hormones
granulosa cell tumors
279
three types of PID
subclinical acute salpingitis chronic PID w/ sequlae
280
when is conservative treatment of ovarian cancer warranted
young people with no children or those with stage one disease with low malignany potential
281
three methods used to control pain during labor
controlled breathing during contractions IV opiates epidural anesthesia
282
one accepted genetic cause of recurrent abortion
balanced translocations
283
DDx for a breast mass
benign cyst (fibrocystic disease or cystic duct) fibroadenoma (benign) cancer fat necrosis lipoma epidermal cyst
284
eclampsia
preeclampsia with grand mal seizures
285
management of HTN during pregnancy
keep blood pressure \<140/90 reduce risks of preeclampsia monitor fetal growth
286
patient who is 30 wks pregnant arrives at the ER after experiencing a rush of fluid from vagina with painless uterine contractions Q45-60 minutes DDx
rupture of the amniotic sac urine blood
287
what triggers the let down reflex
nipple stimulation causes a release of oxytocin and prolactin from the pituitary, increasing milk production and letdown
288
two strategies to manage heart disease during pregnancy
controlling blood pressure avoid additional cardiac stress of L&D
289
why are interstitial pregnancies dangerous
they can be mistaken for IUPs because they are in the uterus and the uterus has a much larger blood supply than the fallopian tubes
290
causes of infertility along with percent incidence
egg/ovulation (25%) sperm problems (30%) tubal/pelvic (30%) unusual problems (5%) Unexplaned (10%)
291
how is breast cancer usually discoved
90% are found as a painless lump in the breast
292
Gravida
being pregnant
293
six requirements to use forceps in augementation of delivery
completely dilated cervix head engaged to pelvis (0 station or lower) position of head must be known position must be a deliverable one membranes ruptured no CPD
294
what happens on the first transfusion from an Rh positive person to an Rh negative person subsequent transfusions
nothing will happpen the body will have sensitized and produce antibodies against Rh factor leading to hemolysis
295
expectant management for preterm PROM
administer ABx, esp for group B streptococus consider glucocorticoid if \<32 weeks
296
how long before the miscarriage does embryo death occur
2-6 weeks
297
when are most people diagnosed with DM I DM II how many people
\<25 \>25 15-20 million, most with DM II
298
three risks associated with pelvic adhesions from PID
chronic pelvic pain infertility increased risk of ectopic
299
what is the racial and gender bias for involutional osteoporosis
more common in women more common in caucasians than blacks
300
why is ferning useful for determining PROM
amniotic fluid will fern on slide due to proteins
301
what to look for on sterile speculum exam for PROM
pooling of fluid on the blade pH of fluid ferning on microscope culture fluid of labor is not imminent or desirable
302
treatment for endometriosis
expectant management with nsaids for benign form ovarian suppression surgery
303
main fetal heart rate changes
normal variation tachy/bradycardia decelerations (late, early, variable)
304
what is the normal fetal presentation for labor
vertex, occiput anterior (OA)
305
what is the main endocrine changes associated with menopause
dramatic reduction in estrogen production resulting in an increase in FSH from the pituitary
306
what is considered a full term pregnancy premature pregnancy
37-41 weeks anything before 37 weeks
307
T/F total placenta previa will not change throughout the course of pregnancy
true, it can become marginal due to uterine growth
308
advantages of endometrial ablation
it will make conception much less likely and can reduce dysmenorrhea or endometrial pain to managable levels
309
preliminary signs of labor
dropping false labor loss of the mucus plug (ww/o bloody show)
310
what percent of sperm in semen are normally motile what is considered mild asthenospermia severe very severe
+40% 20-39% 10-19% \<10%
311
are normally dosed birth control pills usually effective for adenomyosis
no, they need to be continuously dosed
312
two causes of intrauterine adhesions
theraputic ablation asherman's syndrome (scar tissue forming from repeat surgical procedures or trauam
313
changes in insulin needs during the first trimester
insulin secretion and sensitivity rise fasting glucose falls (15mg/dL) effect peaks at 12 weeks
314
what type of breast cancer is the most aggresive but uncommon
inflammatory breast cancer
315
divisions of first labor
prodromal: frequent irregular contractions with no cervical changes latent: contracts become regular and cervix starts to change active: strong, frequent contractions with fast progress
316
how large are typical functional ovarian cysts will they resolve on their own what might have happened if the patient has mild to moderate pain
\<5cm in diamter yes, usually with 1-3 months possibly faster with oral contraceptives the cyst may have ruptured
317
factors the increase risk of endometrial cancer decrease risk
estrogen exposure, genetic factors oral contraceptives, progestin use
318
primary radiation therapy for endometrial cancer
implants in the endometrium or vagina lymph nodes irradiation for mets
319
describe ductal CIS
a localized carcinoma with penetration of the basement membrane with 1-3% having + axillary nodes
320
non-communicating uterine horn
a malformation of the uterus where one side is closed off from the body of the uterus
321
apgar breathing scores
0 = none 1 = weak/irregular 2 = strong
322
indications that a pregnant women in labor should present
frequency of contractions strength of contractions vaginal fluid loss
323
patient pregnant at 12 weeks reports having one episode of syncope what might be the cause?
as she is starting the second trimester blood pressure falls while blood volume is increased; can lead to positional or orthostatic hypotension
324
mullerian agenesis what is this called when its idiopathic how do both present
testicular feminization due to androgen receptor insensitivity mayer-rokitanski-kuster-hauser syndrome primary amenorrhea
325
two refuted causes of spontaneous abortion with exceptions
infection (except listeria and maybe ureaplasma) luteal phase defects
326
GPA
Gravity Parity Abortions G2 P1 A1
327
when are apgar scores taken
1 and 5 minutes post birth
328
treatment of CIN
loop electrosurgical excision procedure (LEEP) cervical cryotherapy cold knife cone biopsy
329
incidence of HELLP syndrome
10% incidence with severe preclampsia
330
what is premarin what is it used for
conjugated estrogen used in HRT for menopause
331
T/F a positive HCG test doesn't mean a patient is pregnant
true, but for OB/GYN purposes a positive HCG means pregnant
332
DDx for a benign cyst
functional (follicular or luteal cyst) benign cystic teratoma (dermoids) endometrioma serous cystadenoma mucinous cystadenomas
333
T/F you should inspect a placenta previa with a digital cervical exam
false, you should never examine a pregnany cervix when there is vaginal bleeding unless you know there is no placenta previa
334
where does amniotic fluid come from what is its function
the fetus, particularly the kidneys shock absorption, participates in the development of lungs
335
what is a double set up exam what is it used for
a sterile speculum exam then a digital exam done in an OR prepped for c section when placenta previa is possible
336
maternal mortality two division
Death of a pregnant woman during pregnancy or within 6 weeks of delivery or termination direct and indirect
337
congenital abnormalities that would cause uterine amenorrhea
mullerian agenesis transverse vaginal septum imperforate hyman
338
risks associated with bisphosphonate use
osteonecrosis of the jaw increase risk of esophageal cancer increased risk of atrial fibrilation
339
what is the largest part of a normal fetus what is the exception to this
the head shoulders in large fetuses with macrosomia
340
in the case of mild oligiospermia or asthenospermia, what action can be taken what about a severe issue
fertility without treatment is possible but intrauterine insemination (IUI) may help fertility without treatment is very unlikely, IVF is the only option
341
when does normal labor occur
37-41 weeks gestational age
342
treatment of pregnant patient with DM I
tight insulin control (multidose insulin, diet, exercise) early delivery (37-39 wks)
343
is there a benefit for performing an annual breast exam important notes for the exam
yes, but a hurried or incomplete exam is useless palpation supine with arm behind head, extra attention in the upper out quadrant, palpate axilla
344
the essential work up for infertility (HEST)
health, eggs, sperm, tubes
345
Apgar pulse scores
0 = absent 1 = \<100/min 2 = \>100 minute
346
where is zero station
when the biparietal diameter passed through the pelvis inlet
347
what is the anatomical landmark for a gravid uterus at 20 weeks 36 weeks
palpable at the umbilicus palpable at the xiphoid
348
treatments for hot flashes
estrogen clonidine (slightly effective) progestin (moderately effective) SSRI (moderate to good efficacy) gabapentin (moderate)
349
how is carcinoma in situ usually diagnosed
mammography
350
T/F there is no way to know if a person with hypothalamic amenorrhea will resume normal estrogen production
no, which is worrisome for osteoporosis
351
criteria for a threatened spontaneous abortion how will a person feel in regards to the pregnancy
any first trimester pregnancy with bleeding with or without cramping some will still feel pregnant, others wont
352
when checking FSH and estradiol for HEST workup, what should the values be what about serum progesterone
FSH \<10 E2 \<80 SP \>9 if taken 7-10 days after LH surge
353
when will heterotopic pregnancy be more common what will US show
in IVF IUP with pelvic pain that mandates laparoscopy
354
treatment of uterine amenorhea caused my mullarian agenesis
supportive (vaginal dilators and careful counselling) surgical
355
blind uterine horn (hematometra)
trapping of blood in the uterus due to a lack of opening
356
hyperemesis gravidarum
severe vomitting related to pregnancy
357
T/F the medical term for abortion as noted in the TPAL system G3 P0030 is always a medical abortion
false, it can be any reason why the fetus was not taken to term (ectopic pregnancy)
358
what is the usual presentation of ovarian cancer screening tests conclusion?
pelvic mass with ascites pelvic exams, CA-125 assays, ultrasound there is no cost effective protocol
359
treatment of fibroids
expectant ovarian suppression anti-progestational therapy radiologica embolization surgery (hysterectomy or myomectomy)
360
breech presentation why might this be converted to a csection
posterior, leg, or foot presents instead of the head because the head comes out last, if it gets stuck delivery might take too long
361
treatment of vasa previa
early recognition c scetion is necessary, can be emergent if fetal bleeding occurs
362
what are the advantages of barrier contraception three types
they are very effective with the right population and they may provide protection against STI diaphram, cervical cap, condoms
363
an Rh negative wants to have a child with an Rh positive father after several SABs can they have a kid
if the dad is Dd there is a 50/50 shot Rh factor won't play a factor if the dad is DD then the fetus will be 100% Rh+
364
HELLP syndrome associated with preeclampsia
H hemolysis EL elevated liver enzymes LP low platelet count
365
what is the risk associated with hyperemesis gravidarum what is the treatment what condition might you suspect to be associated with this
severe dehydration IV hydration with anti-emetics; possible parenteral nutrition; pregnancy termination in severe cases gestational trophoblastic disease
366
take away messages for PCOS
focus on the patients main complaint make sure to test for dyslipidemia/CVD, insulin resistance, endometrial carcinoma
367
why is it important to maintain a high index of suspicion when symptoms point to ectopic pregnancy
1/200 have no risk factors, 20-50% result in high risk situations
368
gestational diabetes
glucose intolerance seend during pregnancy with no hx of DM and normal glucose tolerance after pregnancy
369
one factors that delays menopase four factors that hasten menopause
obesity cigarette smoking, chemo, pelvic radiation
370
why isn't US used to screen for ovarian cancer
increased survival by 50% but lead to many false positives
371
three other producers of HCG
small cell lung cancer testicular cancer liver cancer
372
when would expectant management of placenta previa be indicated
significantly preterm with minimal bleed and the patient is not in labor
373
what is the effect of HRT for menopause on CV health breast cancer risk colon cancer risk congition
not helpful, maybe harmful slight increase in risk maybe decrease risk probably not useful
374
non-stress test for fetal monitoring when is it most useful
comparison of FHR to fetal movement most useful in late pregnancy
375
do theca-lutein cysts need to be removed
no, they will go away on their own when the molar pregnancy is removed
376
SAB second phase
7-12 weeks, heavy cramping and bleeding for several hours followed by expulsion of the gestational sac
377
in what age group does mammography increase survival is it safe what is the most common finding
50-70 yes there is fairly low radiation with modern equipment microcalcification
378
breast cancer treatments
surgery radiation chemo endocrine modulation immune modulation
379
T/F oral contraceptives increase breast cancer risk
probably slightly
380
HTN drugs for use in pregnancy
calcium channel blockers methyldopa clonidine hydralizine
381
treatment for infertility caused by PCOS
reduce insulin resistance (metformin) induce ovulation (clomiphene citrate/clomid or aromatase inhibitor) check for other fertility factors with no pregnacy after 3-4 normal ovulations or intially with risk factors
382
16 yr old patient presents with weight gain, LMP 6 months ago DDx?
ovarian cyst GI tumor ascities bowel obstruction fibroid
383
patient presents with intermittent vaginal bleeding after three months of amenorrhea, persistant nausea and vomitting, high HCG, uterus palpable at the umbilicus what might you suspect
molar pregnancy
384
OB issues with diabetics
birth defects late pregnancy intrauterine fetal death (stillbirth) large fetal size (macrosomia)
385
Diagnosis of PROM
immunochemistry (dipstick) sterile speculum exam
386
T/F a fallopian tube having undergone a salpingostomy will not heal properly and probably not be effective
false, there is a 70% chance it will heal and be useful for pregnancy
387
types of breast reconstructuve surgery
saline implants trans-rectus abdominis muscle flap
388
six types of spontaneous abortion
threatened complete incomplete missed septic recurrent
389
three other types of fetal malpresentations for labor
face or brow breech transverse lie
390
why do SERMs work
because the estrogen receptors in bone are different that those found elsewhere in the body
391
multipara
given birth multiple times
392
treatment for unruptured ectopics
chemotherapy or surgery
393
why is it important tn HCG stay low after removal of a molar pregnancy
because the formation of a choriocarcinoma is likley
394
patient G4P0030, 1st electively terminated at 7 weeks, SAB at 18, SAB at 14 with normal appearing fetuses what is the concern
cervical incompetence
395
26 yr old primigravid pt 7 weeks pregnant, DM I for 7 years what happens to her insulin needs during pregnancy
396
what is the male risk of breast cancer
1/150 that of women with similar risk factors and treatment
397
four factors that cause conditions with prematurity
respiratory GI neurologic visual
398
three less classic symptoms of PCOS
obesity sleep apnea skin changes (acanthosis nigiricans and skin tags)
399
two highlights of the third trimester
labor becomes increasingly likely fetal viability increases rapidly
400
what causes bacterial vaginosis incidence s/s treatment
gardnerella vaginalis in vaginal flora common (15-40%) asymptomatic or may cause vaginitis metronidazole oral/cream, clindamycin vaginal cream
401
late decelerations what do they mean are the concerning
transient bradycardia that starts when the contraction is ending indicates fetal hypoxia if they don't go away with position change or oxygen progress to c section
402
how is the placenta evaluated during an OB ultrasound
location and overall health
403
postmenopausal bleeding DDx
postcoital (cervical polyp or carcinoma) ovulatory abnormal (endometrial hyperplasia/carcinoma)
404
what is the estimated date of delivery
280 days after first day of the last menstrual cycle
405
primary infertility
a couple (particularly the woman) has never been pregnant together
406
at what gestational age is an incomplete SAB more common what are two possible complications what is required
more likely after 10 wks gestation bleeding and cramping can be serious requires uterine curettage
407
false labor
contractions with no cervial changes due to braxton hicks contractions or early labor (prodromal)
408
factors that lower ovarian cancer risk
pregnancy (-15% per pregnancy) oral contraceptives (-50%)
409
pregnant patient with class II heart failure sudden experiences shortness of breath during normal daily activies is this concerning
yes, increasing class during pregnancy is an ominous sign
410
ovarian causes of amenorrhea
primary ovarian failure secondary ovarian failure caued by a pituitary issue or loss of GnRH
411
nulliparous
412
two complications with shoulder dystocia
brain anoxia fetal trauma
413
perimenopause
the period of about 10 years prior to menopause characterized by changes in menstrual cycles and vasomotor flushes (hot flashes)
414
general menopause symptoms
vasomotor flushes
415
distinguish between third trimester bleeding caused by previa vs abruption
previa is painless, abruption is painful
416
what is the disadvantage of the transverse c section when would you do a horizontal incision
it takes long because you have to separate the rectus from the rectus fascia in the case of fetal distress
417
DDx of chronic pelvic pain
dysmenorrhea dysparunia
418
natural course when not lactating
most will complain of engorgement, leaking, pain increasing over 2-3 days then subsiding
419
heterotropic pregnancy
two fertilized eggs implant, one in the uterus one ectopically
420
phases of a spontaneous abortion
first (6-9 weeks) Second (7-12 weeks) recovery
421
what is the long term survivability of breast cancer two big take aways to maximize survival
old standard is 5 years most studies are showing 10 years early diagnosis is crucial and long term surveillance is needed
422
three types of endometrial hyperplasia
hyperplasia without atypia hyperplasia with atypia carcinoma in situ
423
vasomotor flushes what causes them
the inability to regulate temperature cause by misreading by the hypothalamus that triggers cooling mechanisms
424
what is in a gonadotropin fertility drug what are the risks of treatment
FSH with or w/o LH hyperstimulation, multiple births
425
culdocentesis
needle aspiration of the pelvic cul-de-sac to look for free blood
426
four examples of phosphonates
alendronate (fosamax) risedronate (actonel) etidronate (didronel) pamidronate (aredia)
427
key symptoms of PCOS
oligomenorrhea (sometimes with heavy bleeding) or amenorrhea hyperandrogenism (hirsutism, acne, alopecia)
428
T/F estrogen causes breast cancer reasoning?
false, it opens the door to allow for breast cancer to form women without esstrogen have a low risk, men with estrogen do, early menses + late menopause increases risk
429
pro/con for episiotomy midline vs mediolateral
midline is more comfortable during healing mediolateral is less comfortable but less likely to extend into the rectum
430
hydatidform mole risk factors
a neoplasm arising from trophoblastic cells age (very old and very young) diet/socioeconomic factors paternal genome 46yy
431
evaluating abnormal pap smears (ASC-US, LGSIL, HGSIL)
ASC-US: treat any vaginal infections and repeat in 3-6 months for any others colposcopy with directed biopsy
432
suspected cause of PCOS
prolonged anovulation caused by genetics, weight gain or stress that leads to hyperandrogenism, insulin resistance, which positively reinforces anovulation
433
morbidity associated with cervical cancer
local spread and destruction of ureters, bladder, rectum lymphatic spread rare distant metastasis
434
placenta previa
placenta within the zone of cervical effacment and dialtion
435
standard tests for all amenorrhea/oligomenorrhea
Gondatropins: FSH, LH Prolactin TSH HCG Test
436
two ways to evaluate fallopian tubes on a HEST workup
hysterosalpingogram laparoscopy
437
what are two sequlae of PID that might cause chronic problems
tubo-ovarian abscess that requires surgical removal pelvic adhesions
438
explain why coelemic metaplasia could be a cause of endometriosis
retrograde menstruation causea a metaplastic change in the peritoneum and ovarian lining
439
TPAL notation examples
G3 P1101 three pregnancies, 1 term delivery, 1 preterm delivery, 1 living child, no abortsion
440
advantages of SERM (raloxifene/Evista) over estrogen
action is limited to bone safer than estrogen side effects are mimicked by menopausal symptoms may lower breast cancer risk
441
at what point does managing blood pressure during pregnancy become difficult
after 24 weeks
442
placenta accreta treatment why is this troublsome
an abnormality of placental attachment where the placenta is very tightly attached to the uterus manual removal there is no good dissection plane, may require hysterectomy
443
diagnostic difficulties in relation to heart failure and a pregnant patient
normal physiologic changes cause systolic murmurs and JVD pseudo-dyspnea can mimic symptoms PMI shifts due to the uterus
444
when evaluating a semen analysis for infertility what are three things to look at what should happen if the results are abnormal
concentration, motility, volume repeat at 4-8 weeks
445
the difference between primigravida and primipara
the first time being pregnant vs the first time giving birth
446
two medications that can cause osteoporosis
glucocorticoids and heparin
447
traditional reccomendations for threatened spontaneous abortion
bed rest NPV (nothing per vaginum)(
448
managing the patient in premature labor
ABx (gram +) glucocortcoids bed rest transport
449
risk factors or preeclampsia
more common in first pregnancies more common in black women more common with multiple pregnancies more common in low socioeconomic groups
450
if the mother produces antibodies against the babies blood type can it effect the baby?
it might cause jaundice from hemolysis but AB antibodies are IgM and don't pass the placenta
451
what to look for in HCG monitoring following GTD
effective contraception for one year rising HCG levels indicating invasive GTD (20-30%)
452
if a mother is Rh negative and continues to have Rh positive children what is the effect
the mother's anti-d reaction will become strong and stronger
453
two situations where dysmenorrhea might be caused by outflow obstruction
pain at or soon after menarche caused by mullerian fusion or vaginal formation problem pain after surgical procedure due to cervical stenosis
454
why does gardnerella vaginalis cause bacterial vaginosis
unknown, but the bacteria is associated with sexual activity
455
two types of pseudodyspnea due to pregnancy
progesterone-induced tachypnea upward displacement of the diaphragm
456
what happens during an incomplete SAB how is it different from a normal SAB
products of conception ar not completely expelled it is the same until expulsion (second phase)
457
lab test for amenorrhea
HCG FSH/LH TSH Prolactin Test (in cases of hirsuitism) chromosomal analysis (to check for congenital abnormalities)
458
gardasil is most effective when potential benefit
girls and boys 11-12, reccomended 9-26 prevent 70% of cervical cancer 90% genital warts
459
gynecologic causes of placental abruption
uterine malformation or fibroids
460
what other test might be considered for infertility treatment in the presense of oligomenorrhea or amenorrhea what bout oligospermia
serum prolactin chromosomal analysis
461
risk factors for shoulder dystocia
fetal macrosomia maternal obesity previous Hx maternal diabetes post dates multiparity
462
why can "morning sickness" a misnomer
because it can last all day
463
apgar color points
0 = blue all over 1 = body pink, limbs blue 2 = pink all over
464
effects of estrogen that counter act osteoporosis what is the result
stimulates estrogen receptors in bone reduces the effect of parathyroid hormone increases bone mass, reduces fractures
465
preeclampsia/eclampsia
BP \> 140/90 on two or more occasions 6 hours or more apart after 20 weeks WITH proteinuria
466
TPAL four classifications
gravidity plus four classifications of outcomes Term deliveries, preterm deliveries, abortions, living children
467
risk factors for preterm labor
prior preterm labor (6-8X) multiple gestation (6-8x) african american (3-4x) low socioeconomic status (1.9-2.6x)
468
what does the presence of fetal fibronectin in maternal serum indicate
increased risk for preterm labor
469
HPV types 6, 11, 42, 43 are low risk for cervical cancer but are asociated with what
condlyomata and CIN I
470
what is the treatment for cervical incompetence
cerclage (a band wrapped around the external os to keep it closed
471
when would leiomyosarcoma be high on the DDx how are they treated
when there is a rapidly growing uterine mass or suspected fibroid excision
472
causes for pelvic relaxation leading to uterine prolapse
obstetrical deliveries decreased strength of connective tissue due to age decreased estrogen increased abdominal pressure from obesity, chronic cough, constipation
473
treatment for SAB incomplete SAB missed abortion
none curettage D & C or prostaglandin therapy
474
types of abnormal uterine bleeding
oligomenorrhea amenorrhea (primary vs secondary) menometrorrhagia hypermenorrhea/menorrhagia post menopauseal bleeding
475
medical cases of placental abruption
gestational diabetes or HTN
476
two immunochemistry test
amnisure (placental alpha microglobulin 1) Actim prim (IGF bindining protein 1)
477
two phenothiazines used to treat nausea in early pregnancy
promethazine (phenergan) prochlorperazine (compazine)
478
who does the blood from placenta previa come from
usually from the mom, but can be from the fetus in vasa previa
479
compare and contrast lumpectomy vs mastetcomy
similar survival studies with post op radiation lumpectomy is under utilized, but not everyone is a candidate (small breast and large tumor size)
480
urinary menopause symptoms
frequency and incontinence
481
what is a normal semen concentration what is considered mild oligospermia severe very severe
+20million 10-19 million 5-9 million \<5million
482
how do symptoms differ between submucosal and pedunculated fibroids
submucus will have menorrhagia and pressure discomfort from the mass pedunculated will have acute pain due to infarct and dysmenorrhea
483
two advantages of chemotherapy with methotrexate for ectopic
convenient (single dose IM) good success rate (90% optimum success)
484
two key incisions in a c section two orientations of the skin incision four orientations of the uterine incision
skin and uterine midline verticle and pfannensteil (transverse suprapubic) low transverse, low vertical, classical, T
485
SAB symptoms (cramping and bleeding) based on gestational age
5-7 weeks: mild 8-9: moderate \>10 weeks: moderate to severe
486
three types of placenta previa
marginal, complete, low lying
487
causes of hyperprolactiemia that might lead to amenorrhea
pituitary adenoma hypothyroidism drug induced idiopathic
488
cervical incompetence risks when does it occur
painless gradual dilation of the cervix surgery (D&C, conization, LEEP), trauma 14-27 weeks
489
variable deceleration what is the cuase are they concerning
transient bradycardia that can be during or after contractions compression of the umbilical cord can be if the bradycardia goes low enough
490
three ultrasound landmarks and when you would see them
gestational sack (5-5.5 wks) 2mm embryo (5.5-6wks) cardiac activity (5.5-6 wks)
491
two types of abortsion
spontaneous and inducd
492
define gynecology
The study of… diseases & conditions that affect reproduction and the female reproductive system
493
adjunctive therapy associated with breast cancer what is the goal types is chemo needed?
improve long term survival endocrine modulation for estrogen sensitive patients (anti-estrogen and aromatase inhibitors) chemo is not necessary for early stage cancer
494
rectocele vs cystocele
rectocele is posterior vaginal wall weakness cystocele is anterior vaginal wall weakness
495
patient doing a hormone challenge for amenorrhea reports bleeding what does that prove
that ovaries are producing estrogen and the uterus is intact
496
treatment options for primary ovarian failure
HRT egg donation or stem cell gametes for fertility
497
how is it possible to have a full term pregnancy with a nulliparous cervix
cesarean
498
TNM
Tumor: size, Node: lymph node involvement, Metastasis: presence of distant metastasis
499
bethesda system to classify pap smears
normal: negative for CIN, CIS, cancer atypical squamous cells, undetermined or cannot exclude (ASC) low grade squamous intraepithelial lesion (LGSIL) high grade squamous intraepthelial lesion (HGSIL)
500
two types of dysmenorrhea
secondary (due to pelvic pathology primary
501
why are epidurals not reccomended during the latent phase of labor
because it can slow down cervical dilation if it occurs before 4cm dilation
502
is endometriosis diagnosed with ultrasound
no, endometriomas can be seen but endometriosis is confirmed with laprascopy
503
two step principle as it applies to breast cancer
make diagnosis with biopsy first, then treat
504
two uterine causes of amenorrhea
intrauterine adhesion (synchiae) congenital abnormalities
505
patient no previous heart conditions presents with mitral reguritation and pleural edema on CXR is this concerning?
yes, pregnancy will not normally cause diastolic murmurs, +gradeIII systolic murmurs, or pleural edema
506
three preparations before forceps should be used
adquate anesthesia bladder not distended (may require catherization episiotomy
507
glucocorticoid therapy for preterm labor treatment when less than 34 weeks
betamethasone 12 mg IM q24h x 2 doses dexamethasone 6mg IM q6h x 4 doses
508
when is eclampsia diagnosed
50% antepartum 25% intrapartum 25% post partum
509
what is a likely cause of the hypothalamus causing vasomotor flushing
over production of FSH due to low estrogen stimulates the arcuate nucleus, which is near the thermoregulation center and causes spill over
510
changes in insulin needs during the second and third trimester
insulin sensitivity falls (33-50%) fasting and postprandial glucose levels reise
511
hormonal challenge
progestin adminstered 10g x 5-7d, if bleeding starts that means that uterus and ovaries are intact estrogen + progestin adminstered that leads too bleeding proves the uterus is intact
512
T/F fertility drugs are "fertility enhancers" what conditions are not treatable with fertility drugs
false sperm, tubal, uterine issues
513
three ovarian cancer origins
epithelial (90%) germ cell origin stromal/sex cord
514
diagnosis of vaginitis
wet mount on two slides one with saline to look for flagellated trichomonads or clue cells (bacterial vaginosis) one with potassium hydroxide to look for budding yeast
515
what are fertility drugs used for two types
to cause or enhance ovulation gonadotropins, clomiphene
516
classification for neonatal death
death with in the first 28 days
517
counselling for a patient experiencing nausea during pregnancy
rest/reduce stress avoidance of triggers small feedings with trial and error of foods hydration
518
dangers associated with unopposed estrogen
519
strategy for dealing with infertility
discover the causes correct the issue if possible bypass if possible provide support
520
three things associated with monilia causing vaginitis
hormonal changes, ABx, immune status in frequent infections
521
key lab finding for primary ovarian failure
very high FSH
522
why is vasa previa difficult to recognize what is the usualy initial sign
often it doesn;t cause an issue until membranes rupture fetal tachycardia
523
treatment of acute PID
remove IUD if present admit toxic patient for IV ABx outpatient with oral ABx
524
mean age for the onset of natural menopause
51
525
two types of placental abnormalities that can lead to postpartum hemorrhage
retained placental fragment or lobe placenta accreta
526
two types of internal fetal monitoring
fetal scalp electrode for HR intrauterine pressure catheter
527
managemnet of PCOS
screen for other causes of symptoms screen for special health risks treat main symptoms
528
imperforate hymen
a hymen that doesn;t open during development and can trap blood to cause dysmenorrhea
529
clinical factors to keep in mind when assessing a breast lump
most are benign (90% \<20, 60-70\>40) is the mass solid vs cystic mobile vs fixed dimpling or nipple erosion
530
treatment of preterm labor
glucocorticoid therapy tocolysis to delay 1-2 days
531
three aninotic fluid abnormailities
rupture of membranes too much fluid (polyhydramnios) too little fluid (oligohydramnios)
532
two main systems to indicate gravidity and parity when charting
GPA and TPAL
533
biohphysical assesments for to monitor the fetus
fetal movements (kick count) non stress test acoustic stimulation contraction stress test ultrasound assessment
534
what will happen to insulin needs after delivery
insulin resistance decreases, DMII can usually stop all meds, DMI greatly reduce
535
what types of patient would warrant vaginal ultrasounds and CA-125 assays every 6 months
BRCA1-2 positive patients with a first degree relative who had premenopausal ovarian cancer
536
typical course for morning sickness during pregnancy
begins at 5-7 weeks peaks at 8-10 wks usually ends \>12wks but can persist into the third trimester
537
patient presents with * BPs range from 140-155/85-95 * Reflexes +3/4 * C/o slight headache * Mg SO4 started * Platelet count 100,000 can you deliver or should you do c-section
in cases of preeclampsia labor progresses quickly and since unlikey to have SZ, trial labor for 8-12 hours unless HELLP syndrome is suggested by lab work
538
types of germ cell ovarian cancer
dysgerminoma choriocarcinoma embryonal cell carcinoma
539
four accepted causes of reccurrent abortion
maternal age genetic uterine thyroid
540
24 y/0 gravida 1 para 1 complains of 10 days of progressive symptoms: Vaginal discharge, Vaginal itching and irritation, Good general health, Recently completed antibiotics for strep throat infection DDx
vaginitis
541
44 y/o woman, gravida 3 para 3003 reports no menses for 7 months. Also has frequent hot flushes. FSH blood test = 100 mIU/ml with a negative pregnancy test. Is she menopausal?
by clinical standard yes, but occasionally patients can spontaneous restart menses
542
prognosis of intraepithelial lesions
50% will regress to normal 25% will persist 25% will progress to invasive cancer
543
what percent of placenta previa are complete vs partial
20% complete, 80% partial
544
three ways to reduce risk of preeclampsia
BP control rest maybe diet
545
what causes pain with placental abruption
uterine contractions, uterine pain and tenderness at tthe sight of placental separation
546
SAB recovery phase
menstrual period like bleeding for up to 10 days
547
etiology and treatment of a dermoid
etiology: suspected cleavage/growth of an unfertilized oocyte treatment: surgical excision with careful observation
548
criteria for reccurent abortion incidence
3+ SABs especially with no live births
549
contraction stimulation test
add a uterine tocodynamometer to ultrasonic fetal heart monitor, cause 3 contractions over a 10 minute period and observe the FHR in response
550
treatment for uterine prolapse
reduce intraabdominal pressure estrogen replacement kegels surgical repair
551
what is the minimum gestational age for survival
22 weeks
552
hydrops fetalis
fetal congestive heart failure
553
three risk factors for placenta previa
uterine scar from prior c section hypoperfused endometrium (age, multipparity) enlarged placenta (multiple pregnancy)
554
labor equals what
regular contractons that change the effacemtn and dilation of the cervix
555
define obstetrics
The branch of medicine that concerns the management of pregnancy, childbirth and the puerperium
556
complication common with fallope ring for laparoscopic sterlization
can cause cramping 12 hts post op
557
three other treatments for osteoporosis other than estrogen
calcium supplementation 1200-1500 mg/day SERM bisphosphonates
558
how to stimulate contractions for a contraction stimulation test
oxytocin/pitocin breast stimulation orgasm
559
miscellaneous causes of menopause
destruction of oocytes from chemotherapy or autoimmune process
560
endometritis signs
fever, cramping pain, malodorus discharge (lochia) often due to staph, strep, or E coli
561
why is it important that a pregnant patient not lay supine after 20 wks
the uterus is large enough compress the vena cava, reducing venous return and cardiac output
562
three causes of postpartum hemorrhage
uterine atony cervical or vaginal lacerations placental abnormalities
563
why is abnormal prostaglanding production suspected to be the cause of endometriosis
because NSAIDs, which block prostaglandins, tend to work well for endometriosis
564
what is prognosis of ovarian cancer dependent on
stage, age, health, tumor type, tumor grade
565
two forms of neural tube defects
anencephaly spina bifida
566
in a patient with suspected PSOS what tests should be done to exclude alternative causes
early morning serum 17-hyrooxyprogesterone to rule out non-classical congenital adrenal hyperplasia testosterone +2ng/mL to rule out androgen secreting tumor cortisol levels to rule out cushings syndrome
567
treatment of endomettrial cancer
radiation therapy adjuct to surgery or primary surgery (TAH, BSO) progestin, tamoxifen chemotherapy
568
shoulder dystocia
difficulty delivering the shoulders
569
primary surgical treatment for breast cancer
conservative (lumpectomy) mastetctomy axillary nodes
570
what is the genetic paradox in breast cancer
first degree relative with breast cancer increases risk by 3-4x BUT 85% of patients have no family Hx
571
patient presents with early labor at 21 weeks what is the reccomendation
it is up to the patient, but delaying labor will only buy so much time and there is good chance the baby will die
572
T/F most people in the world are Rh positive
true
573
special risk situation for placenta previa
amniotomy (artificial rupture of membranes) can rupture the umbilical cord
574
differentiate between benign and aggressive endometriosis
benign is usually dx at a later age with more superficial lesions and slower progression aggressive with an early onset, more invasive lesions, and rapid progression
575
two types of external fetal monitoring
ultrasound for HR tocodynamometer for detecting contractions
576
preterm labor incidence
labor between 22-36 weeks 11-12&%
577
four types of forceps used for operative delivery
outlet low mid vacuum extractor
578
fetal station
how high is the presenting part of the fetus in relation to the ischial tuberosities
579
pain associated with ovarian torsion
sudden, severe, unilateral pain with no positional relief and possible nausea
580
what is the risk of vasa previa when would you suspect vasa previa
very high risk of fetal death +30% vaginal bleeding with signs of fetal distress
581
suppression of lacatation
avoid nipple stimulation where a very supportive bra estrogen or dopaminergic drugs
582
two types of pregnany induced hypertension
gestational hypertension preeclampsia/eclampsia
583
patient 10 wks pregnant presents with dark/black spotting especially after pap or sexual intercourse. IUP confirmed, fetal assessment via ultrasound shows no signs of fetal distress what is the Dx? how can you be sure?
benign bleeding because the most likely other answers have been excluded
584
why is pH used to determine PROM
if the fluid is acid it probably urine, basic probably amniotic fluid
585
secondary dysmenorrhea causes
endometriosis adenomyosis fibroids outflow obstruction from congenital malformation or cervical stenosis
586
when is methotrexate prefered over surgical management of an ectopic
early on in the pregnancy
587
visual premature disease
retinopathy
588
weeks of pregnancy are calculated used what start date
the first day of the last menstrual period
589
why would a dopamine blocking drug cause hyperprolactinemia
dopamine inhibits release of prolactine from the anterior pituitary
590
apgar reflex/irritability scores
0 = no response 1 = grimace/feeble cry 2 = cough, pulls away
591
types of estrogens combined with progestin used in HRT
combipatch prempro fem HRT
592
what is the prognosis of endometrial hyperplasia w/o atypia with atypia carcinoma in situ
80% regress, 1% progress to cancer considered premalignant, 8-29% progress to CA considered the same as CA
593
risk factors for nausea and vomitting during pregnancy
multiple pregnancy prior motion sickness or migraines personal or family history of morning sickness social factors
594
two things that can be assessed in the first trimester via vaginal ultrasound
IUP vs ectopic pregnancy cardiac activity and size
595
when is fine needle biopsy the only reasonable method for breast cancerq
when assessing masses that are too small to palpate
596
three changes in cardiac output linked to pregnancy
30-50% increase during pregnancy 30% increase during labor 45% increase while pushing
597
three less common presentations of breast cancer
nipple erosion or discharge (pagets) skin dimpling (retraction) inflammatory breast cancer
598
where does oxytocin come from what does it do
posterior pituitary causes contraction of smooth muscle in the breast ducts (let down)
599
prevention of preterm labor
reduce risk factors supplemental progesterone treatment
600
what should be monitored for labor progress
cervical changes strenth and frequency of contractions FHR maternal vital signs, bladder status, discomfort
601
potential PP issues
bladder can be come edematous or atonic rapid cardiovascular changes intiation of lactation
602
what happens to blood volume during pregnancy
increase starting at 8 weeks progressing to a 45% increase in blood volume by weeks 34
603
how common is breech presentation
3-4% of all deliveries are breech
604
five indications for c section
failure to progress fetal distress abnormal fetal lie or presentation prior c section elective
605
T/F vascular resistance falls during the 1st and 2nd semester
true
606
risk of calcium supplementation for osteoporosis
people will overdose themselves thinking more is better and give themselves a kidney stone
607
two types of GTD
hydatidiform mole choriocarcinoma
608
health risk screens for PCOS
endometrial biopsy after age 35 or 15+ years of PCOS lipid profiule screen for insulin resistance and glucose tolerance
609
two types of fetal trauma seen with shoulder dystocia
brachial plexus injury (Erb's palsy) clavicle fracture
610
T/F IUD can be used to treat menorrhagia
true
611
what prevents the uterus from becoming contaminated
cervical mucus plug amniochorion membrane
612
how common are ovarian dermoids what is the age bias are the bilateral or unilateral
25% of all ovarian neoplasms 20-40 15% are bilateral
613
three key factors of labor
powers, pelvis, passenger
614
possible risk factor for polyhydramnios
diabetes, infections, mostly idiopathic
615
what is the single most important cause of perinatal deaths and neonatal morbidity
preterm labor
616
four causes for amenorrhea other than pregnancy
hypothalamic or pitiuitary problem ovarian problem uterine problem metabolic/endocrine issue
617
T/F 50% of pregnancies end +/- 3 wks from LMP
false, 90%
618
HPV 16, 18, 33, 35, 45 are high risk and are associated with what
CIN II, III, cervical cancer
619
four growth measurements used to evaluate fetal health during late pregnancy
uterine size biparietal diameter abdominal circumference femur length
620
three specialistst that should be part of the care team when dealing with a pregnant patient who has heart failure
obstetrician/perinatologist cardiologist anesthesiologist
621
environmental factors associated with breast cancer
high rate in developed nations related to fat intake ETOH slightly increases risk
622
at what point in delivery is the brachial plexus at risk why
delivery of the anterior shoulder too much downward traction can stretch the nerves
623
25 y/o G2 P2002 returns for annual checkup and pap smear On pelvic exam a 4-5 cm mass is palpated in the right adnexa DDx
Benign ovarian cyst ovarian cancer pedunculated leiomyoma
624
causes of functional adnexal cysts
persistant follicle (follicular cyst) persistant cystic corpus luteum (luteal cyst)
625
ovarian cancer stagin
stage one: tumor only in ovaries stage II: tumor limited to pelvis stage III: tumor limited to abdomen Stage IV: distant mets
626
what is the goal of primary breast cancer treatment intial recurrence after that
surgical or medical therapy for a cure still hope with endocrine, chemo, occasional surgical follow up eventually palliative care
627
cephalopelvic disproportion
when the baby's head is too large for the mother's pelvis
628
macrosomia risks
fetus \>10lbs birth trauma such as shoulder dystocia
629
describe the increase in maternal and fetal mortality related to eclampsia
increases maternal mortality 4-5% fetal mortality 13-30%
630
labor defined
regular contractions with cervical effacement and dilation
631
spina bifida
a open defect of the spinal cord where the duramater is exposed
632
gestational diabetes treatment
diet insulin if needed metformin to increase sensitivity
633
definative surgical treatment for endometriosis
total abominal hystectomy with bilateral salpingo-oopherectomy via laparotomy resection or ablation of endometroima laparoscopicly
634
how are breast cancers identified by their hormone receptor
estrogen positive or negative HER-2 positive or negative basal ("triple negative")
635
treatment options for idiopathic infertility
IVF egg donation surrogate IVF
636
why would obesity delay the onset of menopause
adipocytes contain aromatase to convert androgens to estrogens
637
pharmaceutical treatment of nausea during pregnancy
pyridoxine (B6) + doxylamine (diclegis) antihistamine (benadryl) phenothiazines serotonin antagonists
638
partiy
the number of times someone has successfully taken a pregnancy to term
639
what will happen if an Rh negative mom encounters and Rh positive fetus
they will produce IgG against the Rh factor and attack the fetus' blood cells
640
what cllasses of heart failure are at severe risk of death during pregnancy
Class III: symptomatic with normal activies Class IV: symptomatic at rest
641
when is the most common time for a ruptured ectopic pregnancy
between 9-11 weeks
642
stromal/sex cord ovarian cancer
granulosa cell tumor
643
health care issues with the big three vaginitis causes
frequent monilia: immunosuppression trichomonaiasis: other STDs bacterial vaginosis: increased risk of premature labor, increased risk of PID with clap, increased risk of post GYN surgery infection
644
immunologic therapy associated with breast cancer
trastuzumab for HER-2 sensitive cancer trastuzumab emtansine is a chemo drug bonded to trastuzumab
645
how common are spontaneous abortions what is the age bias
15-20% of clinical pregnancies end in spontaneous abortion risk increases with age
646
menometrorrhagia
more frequent menstrual bleeding
647
describe the process of laparoscopic tubal sterlization what are the advantages
coagulation, cutting, or binding the fallopian tube no incisions, very effective, can be reversed, IVF still effective
648
treatment septic abortion
hospitalization with IV ABx and curettage to evacuate uterine contents
649
cancers associated with BRCA1
breast cancer ovarian cancer pancreatic cancer fallopian tube
650
what is the most common cause of secondary ammenorrhea
pregnancy
651
vasa previa what is needed for this to occur
when the fetal blood vessels run across the internal os velamentous insertion or succenturiate lobe
652
breast cancer prognosis divided by receptor status
good: estrogen and progesterone receptors neutral: HER-2 poor: tipple negative, HER-2 without monoclonal antibodies
653
how common is pregnancy related nausea and vomitting
70-85% will have some nausea .5-2% will have severe form (hyperemesis gravidarum)

Clinical Medicine (11 decks)

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